Methods of use to orally and topically treat acne and other skin conditions by administering a 19-nor containing vitamin d analog with or without a retinoid

ABSTRACT

Oral and topical pharmaceutical compositions, kits and methods of treatment thereof for treating various skin disorder including acne, psoriasis, ichthyosis, photoaging, photodamaged skin, and, skin cancer. Exemplary vitamin D analogs as active pharmaceutical ingredients include 2-methylene-19-nor-20(S)-1α-hydroxy-bishomopregnacalciferol, 19-nor-26,27-dimethylene-20(S)-2-methylene-1α,25-dihydroxyvitamin D 3 , 2-methylene-1α,25-dihydroxy-(17E)-17(20)-dehydro-19-nor-vitamin D 3 , 2-methylene-19-nor-(24R)-1α,25-dihydroxyvitamin D 2 , 2-methylene-(20R,25S)-19,26-dinor-1α,25-dihydroxyvitamin D 3 , 2-methylene-19-nor-1α-hydroxy-pregnacalciferol, 1α-hydroxy-2-methylene-19-nor-homopregnacalciferol, (20R)-1α-hydroxy-2-methylene-19-nor-bishomopregnacalciferol, 2-methylene-19-nor-(20S)-1α-hydroxy-trishomopregnacalciferol, 2-methylene-23,23-difluoro-1α-hydroxy-19-nor-bishomopregnacalciferol, 2-methylene-(20S)-23,23-difluoro-1α-hydroxy-19-nor-bishomopregnancalciferol, (2-(3′hydroxypropyl-1′,2′-idene)-19,23,24-trinor-(20S)-1α-hydroxyvitamin D 3 , 2-methylene-18,19-dinor-(20S)-1α,25-dihydroxyvitamin D 3 , a stereoisomer thereof, a prodrug thereof in oral compositions, a salt thereof, and/or a solute thereof. Compounds that activate retinoic acid receptors, such as retinoyls and retinoyl esters, include 13-cis-retinoic acid, all-trans-retinoic acid, (2E,4E,6Z,8E)-3,7-dimethyl-9-(2,6,6-trimethyl-1-cyclohexeneyl)nona-2,4,6,8-tetraenoic acid, 9-(4-methoxy-2,3,6-trimethyl-phenyl)-3,7-dimethyl-nona-2,4,6,8-tetraenoic acid, 6-[3-(1-adamantyl)-4-methoxyphenyl]-2-napthoic acid, 4-[1-(3,5,5,8,8-pentamethyl-tetralin-2-yl)ethenyl]benzoic acid, retinobenzoic acid, ethyl 6-[2-(4,4-dimethylthiochroman-6-yl)ethynyl]pyridine-3-carboxylate, retinoyl t-butyrate, retinoyl pinacol, retinoyl cholesterol, an isomer thereof, a prodrug thereof for oral compositions, an ester thereof, a salt thereof, and/or, a solute thereof. Combinations of such active ingredients demonstrate synergistic efficacy.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.15/136,689 filed Apr. 22, 2016 which is a divisional of U.S. patentapplication Ser. No. 14/034,477 filed Sep. 23, 2013, now U.S. Pat. No.9,339,509, which is a continuation of U.S. patent application Ser. No.13/087,764, filed Apr. 15, 2011, which is a continuation of U.S. patentapplication Ser. No. 11/966,504, filed Dec. 28, 2007, now U.S. Pat. No.8,404,667, which claims priority to and the benefit of commonly-ownedU.S. Provisional Patent Applications 60/882,705 filed on Dec. 29, 2006,61/017,219, filed Dec. 28, 2007 and 61/017,217 filed Dec. 28, 2007 allof which are incorporated herein by reference for all purposes.

This application is related to U.S. patent application Ser. No.10/758,767, filed Jan. 16, 2004, now U.S. Pat. No. 7,964,639. Thisapplication is related to U.S. Pat. No. 7,126,017 issued on Oct. 24,2006.

STATEMENT REGARDING GOVERNMENT INTEREST

Not applicable.

BACKGROUND OF THE INVENTION

Natural and synthetic retinoid compounds have been used to treat avariety of hyperproliferative skin disorders as well as other skindisorders including, for example, acne, psoriasis, wrinkling,sun-damaged skin, and age spots. (See Fox L P et al., Goodman &Gilman's: The Pharmacological Basis of Therapeutics, SectionXIII-Dermatology, 11th Ed.) In many cases, retinoids have been appliedtopically. Retinoic acid has also been administered orally to treatsevere cases of acne. For example, Accutane® contains 13-cis-retinoicacid, also referred to as isotretinoin, which is related to bothretinoic acid and retinol, i.e., vitamin A. (See Remington, The Scienceand Practice of Pharmacy p. 1288-1289, 21^(st) Ed.). Accutane® has beenapproved for treating nodular acne by administering oral pharmacologicdosages of 0.5 to 2.0 mg/kg/day which inhibits sebaceous gland functionand keratinization.

Retinoids are natural and synthetic compounds that are structurallyrelated to vitamin A. All-trans retinol is the major circulating form ofvitamin A. It is oxidized in the body: first to all-trans retinaldehyde,and then to all-trans retinoic acid (atRA). (Blomhoff et al., 1992,Annu. Rev. Nutr. 12:37-57; and, Moise et al., 2007, Biochemistry46:4449-4458). atRA is the functional form of the vitamin that regulatesgrowth, cellular differentiation, and embryonic development, whereasall-trans retinaldehyde functions in the visual cycle. (Clagett-Dame etal., 2002, Annu. Rev. Nutr. 22:347-381). Because at RA is such a potentregulatory molecule, it is formed in very small amounts, and it israpidly metabolized such that its half-life is relatively short.(Roberts et al., 1967, Biochem. J. 102:600-605).

Systemic administration of retinoids has also been indicated fordiseases such as pityriasis, rubra pilaris, condylomata accuminata, skincancers, rosacea, hidradenitis, suppurativa, granuloma annular, lupuserythematosus and lichen planus. (Akyol M et al., 2006, Am. J. Clin.Derm. 6(3), 175-184).

Topical administration of retinoids has been limited largely due to sideeffects such as skin irritation (e.g., redness and burning), dryness andphotosensitivity reactions. (Akhavan et al., 2003, Am. J. Clin.Dermatol. 4:473-492). Oral administration of retinoids has been evenmore limited due to more serious side effects such as teratogenicity(e.g., fetal malformation), elevation of triglyceride, cholesterol, andtransaminase levels, bone demineralization, and other side effectsassociated with topical administration (e.g., drying of mucosalmembranes and photosensitivity). (Armstrong et al., 1994, The Retinoids,pp. 545-572; and, DiGiovanna, 2001, J. Am. Acad. Dermatol.45:S176-S182). Such numerous and varied sided effects have substantiallylimited the medical and pharmaceutical use of retinoids, particularlythose related to skin therapies.

It is believed that retinoic acid and other synthetic retinoids bind toand regulate the transcriptional activity of a family of nuclearproteins known as the retinoic acid receptors (“RARs”). (Chambon, 1996,FASEB J. 10:940-954; Clagett-Dame et al., 1997, Crit. Rev. Euk. GeneExp. 7:299-342; and, Mark et al., 2006, Annu. Rev. Pharmacol. Toxicol.46:451-480). All-trans-retinoic acid is the endogenous ligand for theRAR family of receptors. The 13-cis retinoic acid isomer does not bindto the RARs. (Repa J J et al., 1993, Proc. Natl. Acad. Sci. USA90:7293-7297). The 13-cis retinoic acid isomer must isomerize toall-trans-retinoic acid that is active in terms of receptor binding andactivation.

It has been reported that the active hormonal form of vitamin D (i.e.,calcitriol) and various synthetic analogs thereof demonstratedifferentiative, antiproliferative and immunomodulatory activity. Suchcompounds have also demonstrated therapeutic efficacy in treating skindisease such as psoriasis. (See Smith E L et al, 1988, J. Am. Acad.Dermatol., 19, 516-528; and Holick, M F, 1989, Arch. Dermatol., 125,1692-1697). It is also been reported that calcitriol and therapeuticanalogs thereof are used to target the nuclear vitamin D receptor.(DeLuca H F, 2004, Am. J. Clin. Nutr. (Suppl) 1689S-1696S). It isbelieved that calcitriol and therapeutic analogs thereof may actdirectly within the epidermis on basal keratinocytes and Langerhanscells as well as on other cells within the immune system. The use ofcalcitriol and various synthetic analogs at therapeutic dosages isfurther limited by side effects such as hypercalcemia, hypercalcuria andcalcification of soft tissues.

Recently, a new class of vitamin D analogs, referred to as 19-norvitamin D compounds, has been discovered. 19-Nor vitamin D compounds arecharacterized by replacement of the A-ring exocyclic methylene group atthe 19 carbon (in typical vitamin D molecules) with two hydrogens.Further substitution at the 2-position and/or modification of the sidechain at 17 carbon of the five-membered ring has yieldedpharmacologically active compounds that are much less calcemic atphysiologically active concentrations as compared to the native hormone.(Plum, L. A. et al., Proc. Natl. Acad. Sci. USA, 101(18), 6900-9004(2004)). Some 19-nor-containing vitamin D analogs have also exhibitedenhanced potency and tissue selectivity activities suggesting that suchanalogs may have important therapeutic advantages over the nativevitamin D hormone or other less-selective and/or non-selective analogs.(See Sicinski R R et al., 1998, J. Med. Chem., 41, 4662-4674; and,Shevde N K et al., 2002, Proc. Natl. Acad. Sci. USA, 99(21),13487-13491).

Acne is a condition of the pilosebaceous unit. Acne involves a spectrumof effects including non-inflammatory comedones, inflammatory papules,pustules and cysts. When administered topically or systemically,retinoids cause epidermal hyperproliferation leading to comedolysis andimprovement of the disease. (See Fisher G J et al., 1996, MolecularMechanisms of Retinoid Actions in the Skin, FASEB. J. 10:1002:21013).Although very effective, retinoid therapy is substantially limited bythe number and extent of side effects, which are particularly limitingwhen retinoids are administered orally. (See Fox L P et al., 2006).Thus, there is an important and substantial need for retinoid-containingtherapies having reduced side effects to treat various skin disorderssuch as acne.

SUMMARY OF THE INVENTION

One aspect of the invention is a topical dosage form compositioncomprising a therapeutically effective dose of an active pharmaceuticalingredient containing a 19-nor-containing vitamin D compound, astereoisomer thereof, a salt thereof or a solute thereof, and, apharmaceutically suitable topical carrier system.

In an exemplary embodiment of the topical dosage form composition, the19-nor-containing vitamin D compound is one of the following compounds:

(2-methylene-19-nor-20(S)-1α-hydroxy-bishomopregnacalciferol that isalso referred to herein as 2MBisP),

(19-nor-26,27-dimethylene-20(S)-2-methylene-1α,25-dihydroxyvitamin D₃that is also referred to herein as CAGE-3),

(2-methylene-1α,25-dihydroxy-(17E)-17(20)-dehydro-19-nor-vitamin D₃ thatis also referred to herein as VitIII (17-20E)),

(2-methylene-19-nor-(24R)-1α,25-dihydroxyvitamin D₂ that is alsoreferred to herein as 24R-2MD₂),

(2-methylene-(20R,25S)-19,26-dinor-1α,25-dihydroxyvitamin D₃ that isalso referred to herein as NEL),

(2-methylene-19-nor-1α-hydroxy-pregnacalciferol that is referred toherein as 2MPregna),

(1α-hydroxy-2-methylene-19-nor-homopregnacalciferol that is referred toherein as 2MP),

((20R)-1α-hydroxy-2-methylene-19-nor-bishomopregnacalciferol that isreferred to herein as 20R-2MbisP),

(2-methylene-(20S)-19-nor-1α-hydroxy-trishomopregnacalciferol that isreferred to herein as 2MTrisP),

(2-methylene-(20R)-23,23-difluoro-1α-hydroxy-19-nor-bishomopregnacalciferolthat is referred to herein as FF-44),

(2-methylene-(20S)-23,23-difluoro-1α-hydroxy-19-nor-bishomopregnancalciferolthat is referred to herein as FF-55),

(2-(3′hydroxypropyl-1′,2′-idene)-19,23,24-trinor-(20S)-1α-hydroxyvitaminD₃ that is referred to herein as HPBS),

(2-methylene-18,19-dinor-(20S)-1α,25-dihydroxyvitamin D₃ that isreferred to herein as VD-03), a stereoisomer thereof, a salt thereof,and/or a solute thereof.

In another exemplary embodiment of the topical composition, the compoundis

a stereoisomer thereof, a salt thereof or a solute thereof, and, thedose is in the range of 340 mg to 0.34 μg/kg_(BW)/day. In anotherexemplary embodiment of the topical composition, the carrier systemcomprises 30% to 70% ethanol and 70% to 30% propylene glycol. In anotherexemplary embodiment of the topical composition, the carrier systemcomprises 70% ethanol and 30% propylene glycol.

In another exemplary embodiment of the topical composition, the compoundis

a stereoisomer thereof, a salt thereof, or a solute thereof, and, thedose is in the range of 14 μg to 14 pg/kg_(BW)/day. In another exemplaryembodiment of the topical composition, the carrier system comprises 30%ethanol and 70% propylene glycol.

In another exemplary embodiment of the topical composition, the compoundis

a stereoisomer thereof, a salt thereof or a solute thereof, and, thedose is in the range of 4.5 mg to 4.5 ng/kg_(BW)/day. In anotherexemplary embodiment of the topical composition, the carrier systemcomprises 70% ethanol and 30% propylene glycol.

In another exemplary embodiment of the topical composition, the compoundis

a stereoisomer thereof, a salt thereof, or a solute thereof, and, thedose is in the range of 450 μg to 0.45 ng/kg_(BW)/day. In anotherexemplary embodiment of the topical composition, the carrier systemcomprises 70% ethanol and 30% propylene glycol.

In another exemplary embodiment of the topical composition, the compoundis

a stereoisomer thereof, a salt thereof, or a solute thereof, and, thedose is in the range of 4.5 mg to 4.5 ng/kg_(BW)/day. In anotherexemplary embodiment of the topical composition, the carrier systemcomprises 70% ethanol and 30% propylene glycol.

In another exemplary embodiment of the topical composition, the compoundis

a stereoisomer thereof, a salt thereof, or a solute thereof, and, thedose is in the range of 340 mg to 0.34 μg/kg_(BW)/day. In anotherexemplary embodiment of the topical composition, the carrier systemcomprises 70% ethanol and 30% propylene glycol.

In another exemplary embodiment of the topical composition, the compoundis

a stereoisomer thereof, a salt thereof, or a solute thereof, and, thedose is in the range of 340 mg to 0.34 μg/kg_(BW)/day. In anotherexemplary embodiment of the topical composition, the carrier systemcomprises 70% ethanol and 30% propylene glycol.

In another exemplary embodiment of the topical composition, the compoundis

a stereoisomer thereof, a salt thereof, or a solute thereof, and whereinthe dose is in the range of 340 mg to 0.34 μg/kg_(BW)/day. In anotherexemplary embodiment of the topical composition, the carrier systemcomprises 70% ethanol and 30% propylene glycol.

In another exemplary embodiment of the topical composition, the compoundis

a stereoisomer thereof, a salt thereof, or a solute thereof, and, thedose is in the range of 34 mg to 34 ng/kg_(BW)/day. In another exemplaryembodiment of the topical composition, the carrier system comprises 70%ethanol and 30% propylene glycol.

In another exemplary embodiment of the topical composition, the compoundis

a stereoisomer thereof, a salt thereof, or a solute thereof, and, thedose is in the range of 340 mg to 0.34 μg/kg_(BW)/day. In anotherexemplary embodiment of the topical composition, the carrier systemcomprises 70% ethanol and 30% propylene glycol.

In another exemplary embodiment of the topical composition, the compoundis

a stereoisomer thereof, a salt thereof, or a solute thereof, and, thedose is in the range of 340 mg to 0.34 μg/kg_(BW)/day. In anotherexemplary embodiment of the topical composition, the carrier systemcomprises 70% ethanol and 30% propylene glycol.

In another exemplary embodiment of the topical composition, the compoundis

a stereoisomer thereof, a salt thereof, or a solute thereof, and, thedose is in the range of 41 mg to 41 ng/kg_(BW)/day. In another exemplaryembodiment of the topical composition, the carrier system comprises 70%ethanol and 30% propylene glycol.

In another exemplary embodiment of the topical composition, the compoundis

a stereoisomer thereof, a salt thereof, or a solute thereof, and, thedose is in the range of 11 μg to 0.11 ng/kg_(BW)/day. In anotherexemplary embodiment of the topical composition, the carrier systemcomprises 70% ethanol and 30% propylene glycol.

Another aspect of the invention is a method of treating acne comprisingthe steps or acts of topically administering daily or intermittently anyone of the topical compositions above to a human.

Another aspect of the invention is a method of reducing comedone areacomprising the steps or acts of topically administering daily orintermittently any one of the topical compositions above to a human.

Another aspect of the invention is a method of treating psoriasiscomprising the steps or acts of topically administering daily orintermittently any one of the topical compositions above to a human.

Another aspect of the invention is a method of treating ichthyosiscomprising the steps or acts of topically administering daily orintermittently any one of the topical compositions above to a human.

Another aspect of the invention is a method of treating photoaging orphotodamaged skin comprising the steps or acts of topicallyadministering daily or intermittently any one of the topicalcompositions above to a human.

Another aspect of the invention is a method of treating skin cancercomprising the steps or acts of topically administering daily orintermittently any one of the topical compositions above to a human.

Another aspect of the invention is an oral dosage form compositioncomprising a therapeutically effective dose of an active pharmaceuticalingredient comprising a 19-nor-containing vitamin D compound, astereoisomer thereof, a prodrug thereof, a salt thereof or a solutethereof, and, a pharmaceutically suitable oral carrier system.

In an exemplary embodiment of the oral composition, the19-nor-containing vitamin D compound is one of the following compounds:

a stereoisomer thereof, a prodrug thereof, a salt thereof, and/or asolute thereof.

In another exemplary embodiment of the oral composition, the compound is

a stereoisomer thereof, a prodrug thereof, a salt thereof, or a solutethereof, and, the dose is in the range of 7.0 mg to 7.0 ng/kg_(BW)/day.In another exemplary embodiment of the oral composition, the carriersystem comprises an oil.

In another exemplary embodiment of the oral composition, the compound is

a stereoisomer thereof, a prodrug thereof, a salt thereof, or a solutethereof, and, the dose is 700 ng to 0.7 pg/kg_(BW)/day.

In another exemplary embodiment of the oral composition, the compound is

a stereoisomer thereof, a prodrug thereof, a salt thereof or a solutethereof, and, the dose is in the range of 23 μg to 23 pg/kg_(BW)/day.

In another exemplary embodiment of the oral composition, the compound is

a stereoisomer thereof, a prodrug thereof, a salt thereof, or a solutethereof, and, the dose is in the range of 230 μg to 230 pg/kg_(BW)/day.

In another exemplary embodiment of the oral composition, the compound is

a stereoisomer thereof, a prodrug thereof, a salt thereof, or a solutethereof, and wherein the dose is in the range of 230 μg to 230pg/kg_(BW)/day.

Another aspect of the invention is a method of treating acne comprisingthe steps or acts of orally administering daily or intermittently anyone of the oral compositions above to a human.

Another aspect of the invention is a method of reducing comedone areacomprising the steps or acts of orally administering daily orintermittently any one of the oral compositions above to a human.

Another aspect of the invention is a method of treating psoriasiscomprising the steps or acts of orally administering daily orintermittently any one of the oral compositions above to a human.

Another aspect of the invention is a method of treating ichthyosiscomprising the steps or acts of orally administering daily orintermittently any one of the oral compositions above to a human.

Another aspect of the invention is a method of treating photoaging orphotodamaged skin comprising the steps or acts of orally administeringdaily or intermittently any one of the oral compositions above to ahuman.

Another aspect of the invention is a method of treating skin cancercomprising the steps or acts of orally administering daily orintermittently any one of the oral compositions above to a human.

Another aspect of the invention is a pharmaceutical kit comprising anoral dosage form composition comprising a first therapeuticallyeffective dose of a first pharmaceutical active ingredient comprising acompound or prodrug thereof that activates the retinoic acid receptorincluding, for example, a retinoic acid compound, an isomer thereof, anester thereof, a salt thereof, or a solute thereof, and, apharmaceutically suitable oral carrier system, and, a topical dosageform composition comprising a second therapeutically effective amount ofa second active pharmaceutical ingredient comprising a 19-nor-containingvitamin D compound, a stereoisomer thereof, a prodrug thereof, a saltthereof or a solute thereof, and, a pharmaceutically suitable topicalcarrier system.

In an exemplary embodiment of the pharmaceutical kit, the19-nor-containing vitamin D compound is one of the following compounds:

a stereoisomer thereof, a salt thereof, and/or a solute thereof.

In another exemplary embodiment of the pharmaceutical kit, the compoundor prodrug thereof that activates the retinoic acid receptor is one ofthe following compounds:

(13-cis-retinoic acid that is also referred to as isotretinoin and thatis the active ingredient in Roaccutane®, Annesteem®, Claravis®, Sortret®and Accutane®),

(all-trans-retinoic acid that is also referred to as tretinoin)(all-trans RA was used in the experiments because it is the active formderived from the prodrug, 13-cis RA that is approved for oral use),

((2E,4E,6Z,8E)-3,7-dimethyl-9-(2,6,6-trimethyl-1-cyclohexeneyl)nona-2,4,6,8-tetraenoicacid that is also referred to as 9-cis-retinoic acid and alitretinoinand that is the active ingredient in Panretin®),

(9-(4-methoxy-2,3,6-trimethyl-phenyl)-3,7-dimethyl-nona-2,4,6,8-tetraenoicacid and that is also referred to as acitretin and that is the activeingredient in Soriatane®),

(6-[3-(1-adamantyl)-4-methoxyphenyl]-2-napthoic acid that is alsoreferred to as adapalene and CD417 and that is the active ingredient inDifferin®),

(4-[1-(3,5,5,8,8-pentamethyl-tetralin-2-yl)ethenyl]benzoic acid that isalso referred to as bexarotene and LGD1069 and that is the activeingredient in Targretin®),

(retinobenzoic acid that is also referred to as tamibarotene and that isthe active ingredient in Amnoid®),

(ethyl 6-[2-(4,4-dimethylthiochroman-6-yl)ethynyl]pyridine-3-carboxylatethat is also referred to as tazarotene and that is the active ingredientin Tazorac®, Avage®, and Zorac®),

(retinoyl cholesterol), an isomer thereof, an ester thereof, a saltthereof, and/or, a solute thereof.

Another aspect of the invention is a pharmaceutical kit comprising anoral dosage form composition comprising a first therapeuticallyeffective dose of a first active pharmaceutical ingredient comprising acompound according to the formula

a prodrug thereof, an isomer thereof, an ester thereof, a salt thereof,or a solute thereof, and, a pharmaceutically suitable oral carriersystem, and, a topical dosage form composition comprising a secondtherapeutically effective dose of a second active pharmaceuticalingredient comprising a compound according to the formula

a stereoisomer thereof, a salt thereof, or a solute thereof, and, apharmaceutically suitable topical carrier system.

In an exemplary embodiment of the kit, the first therapeuticallyeffective dose is in the range of 5 ng/kg_(BW)/day to 1 mg/kg_(BW)/day,and the second therapeutically effective dose is in the range of 340 mgto 0.34 pg/kg_(BW)/day.

In another exemplary embodiment of the kit, the topical carrier systemcomprises 30% to 70% ethanol and 70% to 30% propylene glycol.

In another exemplary embodiment of the kit, the topical carrier systemcomprises 70% ethanol and 30% propylene glycol.

Another aspect of the invention is a pharmaceutical kit comprising anoral dosage form composition comprising a first therapeuticallyeffective dose of a first active pharmaceutical ingredient comprising acompound according to the formula

a prodrug thereof, an isomer thereof, an ester thereof, a salt thereof,or a solute thereof, and, a pharmaceutically suitable oral carriersystem, and, a topical dosage form composition comprising a secondtherapeutically effective dose of a second active pharmaceuticalingredient comprising a compound according to the formula

a stereoisomer thereof, a salt thereof, or a solute thereof, and, apharmaceutically suitable topical carrier system. In an exemplaryembodiment of the pharmaceutical kit, the first therapeuticallyeffective dose is in the range of 50 ng/kg_(BW)/day to 10mg/kg_(BW)/day, and the second therapeutically effective dose is in therange of 340 mg to 0.34 μg/kg_(BW)/day. In another exemplary embodimentof the pharmaceutical kit, the topical carrier system comprises 30% to70% ethanol and 70% to 30% propylene glycol. In another exemplaryembodiment of the pharmaceutical kit, the topical carrier systemcomprises 70% ethanol and 30% propylene glycol.

Another aspect of the invention is a method of treating acne comprisingthe steps or acts of administering daily or intermittently any one ofthe kits above to a human.

Another aspect of the invention is a method of reducing comedone areacomprising the steps or acts of administering daily or intermittentlyany one of the kits above to a human.

Another aspect of the invention is a method of treating psoriasiscomprising the steps or acts of administering daily or intermittentlyany one of the kits above to a human.

Another aspect of the invention is a method of treating ichthyosiscomprising the steps or acts of administering daily or intermittentlyany one of the kits above to a human.

Another aspect of the invention is a method of treating photoaging orphotodamaged skin comprising the steps or acts of administering daily orintermittently any one of the kits above a human.

Another aspect of the invention is a method of treating skin cancercomprising the steps or acts of administering daily or intermittentlyany one of the kits above to a human.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 illustrates the comedone area determination, whereby the area ofeach comedone is determined using a MetaMorph® Imaging System, wherebythe system provides the area values for each individual comedone inpixels (see delineated inset area), and whereby the system is moreaccurate than prior comedone profiling techniques.

FIG. 2 is a bar graph showing treatment of Rhino mice using atRAproducing a dose-dependent reduction in comedone area, whereby thecomedone area was analyzed after 3 weeks of oral treatment with variousdoses of atRA, whereby the dose measuring 0.83 mole/kg_(BW) produced aninsignificant reduction in comedone size as compared to the vehiclecontrol, and whereby the dose measuring 16.6 mole/kg_(BW) produced amaximal reduction in comedone size as compared to the vehicle control.

FIG. 3 is a bar graph showing topical treatment of Rhino mice using2-methylene-19-nor-20(S)-1α-hydroxy-bishomopregnacalciferol (2MBisP)alone and19-nor-26,27-dimethylene-20(S)-2-methylene-1α,25-dihydroxyvitamin D₃(CAGE-3) alone in a carrier vehicle containing 30 vol % ethanol and 70vol % propylene glycol producing a reduction in comedone area, wherebythe comedone area was analyzed after 3 weeks of topical treatment,whereby 2MBisP was applied topically in a dose of 5.4 jag/day (ca. 800nmole/kg_(BW)/day), whereby CAGE-3 was applied topically initially atdose of 0.9 ng/day (ca. 100 pmole/kg_(BW)/day) and at reduced doses of0.45 ng/day beginning on day 10 and 0.22 ng/day (ca. 25pmole/kg_(BW)/day) beginning on day 19 (three male mice were not treatedon day 19), and whereby 2MBisP and CAGE-3 caused a reduction in thecomedone area as compared to the vehicle control.

FIG. 4 shows exemplary skin sections from female Rhino mice stained withhaematoxylin and eosin (“H&E”) after being treated with 2MBisP alone andCAGE-3 alone as described in FIG. 3, whereby treatment with 2MBisPreduced comedone area, whereby treatment with CAGE-3 also reducedcomedone area, as compared to treatment with the vehicle only.

FIG. 5 is a bar graph showing comedone area for Rhino mice treatedtopically with 2MBisP alone at a doses of 220 nmole/kg_(BW)/day and 653nmole/kg_(BW)/day, whereby the API was formulated in a carrier vehiclecomprising 30 vol % ethanol and 70% propylene glycol, whereby comedonearea was analyzed after 3 weeks of daily topical treatment, whereby thelowest dose of 2MBisP alone produced no effect, and whereby the higherdose of 2MBisP produced a near-maximal reduction in comedone area.

FIG. 6 is a bar graph showing comedone area for Rhino mice treatedtopically with 2MBisP alone at a doses of 220 nmole/kg_(BW)/day and 653nmole/kg_(BW)/day, whereby the API was formulated in a carrier vehiclecomprising 70 vol % ethanol and 30 vol % propylene glycol, wherebycomedone area was analyzed after 3 weeks of daily topical treatment,whereby the topical dose of 220 nmole/kg_(BW)/day of 2MBisP caused overa 50% reduction in comedone area, whereby efficacy improved due toincreased ethanol concentration (as compared to the carrier vehicle usedin FIG. 6), and whereby the 653 nmole/kg_(BW)/day dose yielded greaterreduction in comedone area as compared to the lower dose.

FIG. 7 is a bar graph showing comedone area for Rhino mice treatedtopically with 2MBisP alone at doses of 22 nmole/kg_(BW)/day, 69nmole/kg_(BW)/day, and 220 nmole/kg_(BW)/day, whereby the API wasformulated in a carrier vehicle comprising 70 vol % ethanol and 30 vol %propylene glycol, whereby comedone area was analyzed after 3 weeks ofdaily topical treatment, whereby the lower 2 doses of 2MBisP produced noeffect, whereby the higher dose of 2MBisP produced a significantreduction in comedone area, and whereby efficacy improved by increasingethanol in the carrier vehicle from 30 vol % to 70 vol %.

FIG. 8 is a bar graph comparing comedone area for Rhino mice treatedtopically with 2MBisP alone at doses of 217 nmole/kg_(BW)/day, and 694nmole/kg_(BW)/day and other Rhino mice treated topically with 20R-2MBisPalone at doses of 217 nmole/kg_(BW)/day, and 694 nmole/kg_(BW)/day (allrelative to Rhino mice treated topically with the carrier vehiclealone), whereby the API was formulated in a carrier vehicle comprising70 vol % ethanol and 30 vol % propylene glycol, whereby comedone areawas analyzed after 3 weeks of daily topical treatment, whereby bothdoses of 2MBisP produced a significant reduction in comedone arearelative to the vehicle-treated group, whereby the lower dose of20R-2MBisP alone produced an insignificant effect, and, whereby thehigher dose of 20R-2MBisP produced a significant reduction showing thatthe 2MBisP with the methyl group in the 20S position is approximately ½log more potent than the 20R-2MBisP compound in the reduction ofcomedone area.

FIG. 9 is a bar graph comparing comedone area for Rhino mice treatedtopically with 2MPregna alone, 2MP alone, 2MBisP alone, and 2MTrisPalone at a dose of 217 nmole/kg_(BW)/day (all relative to Rhino micetreated topically with the carrier vehicle alone), whereby the API wasformulated in a carrier vehicle comprising 70 vol % ethanol and 30 vol %propylene glycol, whereby the comedone area was analyzed after 3 weeksof daily topical treatment, whereby doses of 2MPregna, 2MBisP and2MTrisP each produced a significant reduction in comedone area comparedto those receiving vehicle alone, and whereby doses of 2MP showed asmaller reduction in comedone area.

FIG. 10 is a bar graph comparing comedone area for Rhino mice treatedtopically with 2MBisP alone at doses of 69 nmole/kg_(BW)/day and 217nmole/kg_(BW)/day, Rhino mice treated topically with FF-44 alone atdoses of 69 nmole/kg_(BW)/day and 217 nmole/kg_(BW)/day, and Rhino micetreated topically with FF-55 alone at doses of 69 nmole/kg_(BW)/day and217 nmole/kg_(BW)/day (all relative to Rhino mice treated topically withthe carrier vehicle alone), whereby the respective API's were formulatedin a carrier vehicle comprising 70 vol % ethanol and 30 vol % propyleneglycol, whereby comedone area was analyzed after 3 weeks of dailytopical treatment, whereby the higher doses of 2MBisP, FF-44, and FF-55produced a significant reduction in comedone area relative to thevehicle-treated group, whereby the lower dose of 2MBisP increasedcomedone size, and whereby the lower doses of FF-44 alone and FF-55produced and insignificant effect.

FIG. 11 is a bar graph showing comedone area for Rhino mice treatedtopically with 2MBisP alone, FF-44 alone, and FF-55 alone at a dose of217 nmole/kg_(BW) whereby the drug was applied either on a daily basis(total of 22 doses) or intermittently every Monday, Wednesday, andFriday (total of 10 doses), whereby the results are expressed as apercent of the vehicle-treated groups, respectively, whereby the API wasformulated in a carrier vehicle comprising 70 vol % ethanol and 30 vol %propylene glycol, whereby comedone area was analyzed in skin sectionstaken from Rhino mice 72 h following the final topical treatment dose,whereby 2MBisP, FF-44, and FF-55 each produced a significant reductionin comedone area relative to the vehicle-treated group when applied on adaily basis, and whereby 2MBisP, FF-44, and FF-55 each produced asignificant reduction in comedone area relative to the vehicle-treatedgroup when applied intermittently as compared to daily treatment.

FIG. 12 is a bar graph showing the comedone area for Rhino mice treatedorally with 2MBisP alone at a dose of 522 nmole/kg_(BW)/day and CAGE-3alone at a dose of 68 pmole/kg_(BW)/day, whereby the comedone area wasanalyzed after 24 days of daily oral administration, and whereby bothAPI's produced a reduction in the comedone area.

FIG. 13 is a bar graph showing comedone area for Rhino mice treatedorally with 24R-2MD₂ alone at a dose of 2.3 nmole/kg_(BW)/day and VitIII(17-20E) alone at a dose of 24 nmole/kg_(BW)/day, whereby the comedonearea was analyzed after 24 days of daily oral administration, andwhereby no significant reduction in comedone area was observed.

FIG. 14 is a bar graph showing comedone area for Rhino mice treatedorally with NEL alone at doses of 7.5 nmole/kg_(BW)/day and 25nmole/kg_(BW)/day, whereby the comedone area was analyzed after 24 daysof daily oral administration, and whereby no significant reduction incomedone area was observed.

FIG. 15 is a bar graph showing the comedone area of Rhino mice orallytreated with atRA alone for 24 days and receiving the topical vehiclefor 21 days, Rhino mice topically treated with 2MBisP alone for 21 daysin carrier (30 vol % ethanol and 70 vol % propylene glycol) andreceiving the oral vehicle for 24 days, and Rhino mice orally treatedwith atRA for 24 days in combination with being topically treated with2MBisP for 21 days, whereby comedone area was analyzed in skins takenfrom Rhino mice 4 hours after the final oral dose of vehicle or atRA,whereby the combination therapy using atRA and 2MBisP synergisticallyreduced comedone area, whereby treatment using the oral dose of atRAalone with the topical vehicle lacked significant efficacy, whereby thetopical dose of 2MBisP alone with the oral vehicle lacked significantefficacy, and whereby treatment using atRA alone or 2MBisP alone lackedsignificant efficacy in view of the vehicle control group.

FIG. 16 illustrates skin sections from female Rhino mice stained withH&E, whereby the mice were treated orally with atRA alone (830nmole/kg_(BW)/day) in an oral vehicle (Wesson® soybean oil), topicallywith 2MBisP alone (0.22 μmole/kg_(BW)/day) in a topical vehicle (30%ethanol and 70% propylene glycol), and a combination of atRA orally and2MBisP topically, whereby atRA treatment alone did not alter skinmorphology significantly as compared to the vehicle control, whereby the2MBisP topical treatment alone did not alter skin morphologysignificantly, and whereby treatment with the combination of atRA and2MBisP unexpectedly, synergistically and significantly reduced thecomedone area and the number of comedones.

DETAILED DESCRIPTION OF THE EXEMPLARY EMBODIMENTS

There exists a need for improved therapeutic agents, either oral ortopical, that maintain efficacy of existing therapies while also havingan improved toxicity profile.

The invention is generally directed at oral and topical pharmaceuticalcompositions, kits and methods of treatment thereof for treating variousskin disorder including acne, psoriasis, ichthyosis, photoaging,photodamaged skin, and, skin cancer. Exemplary vitamin D analogs asactive pharmaceutical ingredients include2-methylene-19-nor-20(S)-1α-hydroxy-bishomopregnacalciferol,19-nor-26,27-dimethylene-20(S)-2-methylene-1α,25-dihydroxyvitamin D₃,2-methylene-1α,25-dihydroxy-(17E)-17(20)-dehydro-19-nor-vitamin D₃,2-methylene-19-nor-(24R)-1α,25-dihydroxyvitamin D₂,2-methylene-(20R,25S)-19,26-dinor-1α,25-dihydroxyvitamin D₃,2-methylene-19-nor-1α-hydroxy-pregnacalciferol,1α-hydroxy-2-methylene-19-nor-homopregnacalciferol,(20R)-1α-hydroxy-2-methylene-19-nor-bishomopregnacalciferol,2-methylene-19-nor-(20S)-1α-hydroxy-trishomopregnacalciferol,2-methylene-23,23-difluoro-1α-hydroxy-19-nor-bishomopregnacalciferol,2-methylene-(20S)-23,23-difluoro-1α-hydroxy-19-nor-bishomopregnancalciferol,(2-(3′hydroxypropyl-1′,2′-idene)-19,23,24-trinor-(20S)-1α-hydroxyvitaminD₃, 2-methylene-18,19-dinor-(20S)-1α,25-dihydroxyvitamin D₃, astereoisomer thereof, a prodrug thereof in oral compositions, a saltthereof, and/or a solute thereof. Compounds that activate retinoic acidreceptors, such as retinoyls and retinoyl esters, include13-cis-retinoic acid, all-trans-retinoic acid,(2E,4E,6Z,8E)-3,7-dimethyl-9-(2,6,6-trimethyl-1-cyclohexeneyl)nona-2,4,6,8-tetraenoicacid,9-(4-methoxy-2,3,6-trimethyl-phenyl)-3,7-dimethyl-nona-2,4,6,8-tetraenoicacid, 6-[3-(1-adamantyl)-4-methoxyphenyl]-2-napthoic acid,4-[1-(3,5,5,8,8-pentamethyl-tetralin-2-yl)ethenyl]benzoic acid,retinobenzoic acid, ethyl6-[2-(4,4-dimethylthiochroman-6-yl)ethynyl]pyridine-3-carboxylate,retinoyl t-butyrate, retinoyl pinacol, retinoyl cholesterol, an isomerthereof, a prodrug thereof for oral compositions, an ester thereof, asalt thereof, and/or, a solute thereof. Combinations of such activeingredients demonstrate synergistic efficacy.

2-Methylene-19-nor-20(S)-1α-hydroxy-bishomopregnacalciferol (2MBisP) andmethods of making the compound are disclosed in U.S. patent applicationSer. No. 11/283,163 filed on Nov. 22, 2005, which is incorporated hereinby reference. Salts and solutes of2-methylene-19-nor-20(S)-1α-hydroxy-bishomopregnacalciferol (and othervitamin D analogs herein) can be made using conventional syntheticmethods well known in the art.2-Methylene-19-nor-20(S)-1α-hydroxy-bishomopregnacalciferol is alsodiscussed in Plum, L. A. et al., Biologically active noncalcemic analogsof 1α,25-dihydroxyvitamin D with an abbreviated side chain containing nohydroxyl, PNAS vol. 101, no. 18, 6900-6904 (May 4, 2004).

19-Nor-26,27-dimethylene-20(S)-2-methylene-1α,25-dihydroxyvitamin D₃(CAGE-3) and methods of making the compound are disclosed in U.S. Pat.No. 6,696,431, which is incorporated herein by reference. Salts andsolutes of19-nor-26,27-dimethylene-20(S)-2-methylene-1α,25-dihydroxyvitamin D₃ mayalso be made using conventional synthetic methods well known in the art.

2-methylene-1α,25-dihydroxy-(17E)-17(20)-dehydro-19-nor-vitamin D₃(Vit-III (17-20E)) and methods of making the compound are disclosed inU.S. Patent Application Publication Nos. 2006/0111330 and 2006/0116351,which are incorporated herein by reference. Salts and solutes of VitIII(17-20E) may also be made using conventional synthetic methods wellknown in the art.

2-methylene-19-nor-(24R)-1α,25-dihydroxyvitamin D₂ (24R-2MD₂) andmethods of making the compound are disclosed in U.S. Pat. No. 7,232,810,which is incorporated herein by reference. Salts, stereoisomers,prodrugs and solutes of 24R-2MD₂ and the other 19-nor containing vitaminD compounds herein may also be made using conventional synthetic methodswell known in the art.

2-methylene-(20R,25S)-19,26-dinor-1α,25-dihydroxyvitamin D₃ (NEL) andmethods of making the compound are disclosed in commonly-owned U.S.patent application Ser. No. 11/669,029, filed Jan. 30, 2007 (US2007/0191316), which is incorporated herein by reference. Salts andsolutes of NEL may also be made using conventional synthetic method wellknown in the art.

2MPregna and methods of making the compound are disclosed incommonly-owned U.S. Pat. No. 6,566,352, which is incorporated herein byreference.

2MP and methods of making the compound are disclosed in commonly-ownedU.S. Pat. No. 6,774,251, which is incorporated herein by reference.

20R-2MbisP and methods of making the compound are disclosed incommonly-owned U.S. patent application Ser. No. 11/282,972, which isincorporated herein by reference.

2MTrisP and methods of making the compound are disclosed incommonly-owned U.S. patent application Ser. No. 11/282,304, filed onNov. 18, 2005, which is incorporated herein by reference.

FF-44 and methods of making the compound are disclosed commonly-owned inU.S. Provisional Patent Application No. 61/017,219, filed on Dec. 28,2007, which is incorporated herein by reference.

FF-55 and methods of making the compound are disclosed in commonly-ownedU.S. Provisional Patent Application No. 61/017,217, filed on Dec. 28,2007, which is incorporated herein by reference.

HPBS and methods of making the compound are disclosed in commonly-ownedU.S. patent application Ser. No. 11/732,924, filed on Apr. 5, 2007,which is incorporated herein by reference.

VD-03 and methods of making the compound are disclosed in commonly-ownedU.S. Patent Application Publication Nos. 2006/0189532 and 2007/0105774,which are both incorporated herein by reference.

U.S. Patent Application Publication No. 2005/0119242 also disclosesmethods of making and using several of the 19-nor-containing compoundsused herein, which is also incorporated herein.

All-trans-retinoic acid (atRA) is a commercially available API inproducts such as Vesanoid®. Methods of making synthetic atRA and salts,esters and solutes thereof are well known in the art. Salts, esters,isomers, prodrugs and solutes of atRA and the other retinoids herein mayalso be made using conventional synthetic methods well known in the art.

Retinoid compounds, analogs and derivatives thereof, as used herein,refer to vitamin A and its analogs, whereby the retinoid compounds,analogs and derivatives thereof function by binding to and regulatingtranscriptional activity of RAR. (See also Remingtons p. 1695-1696).Various retinoid compounds and methods thereof useful in the inventionare disclosed in U.S. Pat. Nos. 4,841,038; 5,880,292; 4,757,140;5,808,120; and, 4,966,965, and U.S. Patent Application Publication No.US2005/0085539, which are all incorporated herein by reference. Otherretinoid/retinoyl, modified retinoid/retinoyl and retinoid/retinoylester compounds useful in the invention are disclosed in U.S. Pat. No.7,126,017 and U.S. Patent Application Publication 2004/0167215, whichare hereby incorporated herein by reference.

As used herein, “therapeutically effective dose” and “administering to ahuman a therapeutically effective dose” refers to an amount of one ormore APIs sufficient to treat (e.g., prophylactic, treating the activecondition or curing) one or more of acne vulgaris, psoriasis,ichthyosis, photoaging, photodamaged skin, and skin cancer.

As used herein, the phrase “compounds and prodrugs thereof that activatethe retinoic acid receptor including, for example, a retinoic acid” andthe like means compounds that bind to and regulate the transcriptionalactivity of a family of nuclear proteins known as the retinoic acidreceptors (“RARs”). (Chambon, 1996, FASEB J. 10:940-954; Clagett-Dame etal., 1997, Crit. Rev. Euk. Gene Exp. 7:299-342; and, Mark et al., 2006,Annu. Rev. Pharmacol. Toxicol. 46:451-480).

The pharmaceutically suitable topical and oral carrier systems (alsoreferred to as drug delivery systems, which are modern technology,distributed with or as a part of a drug product that allows for theuniform release or targeting of drugs to the body) preferably includeFDA-approved and/or USP-approved inactive ingredients. Under 21 CFR210.3(b)(8), an inactive ingredient is any component of a drug productother than the active ingredient. According to 21 CFR 210.3(b)(7), anactive ingredient is any component of a drug product intended to furnishpharmacological activity or other direct effect in the diagnosis, cure,mitigation, treatment, or prevention of disease, or to affect thestructure or any function of the body of humans or other animals. Activeingredients include those components of the product that may undergochemical change during the manufacture of the drug product and bepresent in the drug product in a modified form intended to furnish thespecified activity or effect. As used herein, a kit (also referred to asa dosage form) is a packaged collection of related material.

As used herein, the topical dosage form includes various dosage formsknown in the art such as lotions (an emulsion, liquid dosage form,whereby this dosage form is generally for external application to theskin), lotion augmented (a lotion dosage form that enhances drugdelivery, whereby augmentation does not refer to the strength of thedrug in the dosage form), gels (a semisolid dosage form that contains agelling agent to provide stiffness to a solution or a colloidaldispersion, whereby the gel may contain suspended particles), ointments(a semisolid dosage form, usually containing <20% water and volatiles5and >50% hydrocarbons, waxes, or polyols as the vehicle, whereby thisdosage form is generally for external application to the skin or mucousmembranes), ointment augmented (an ointment dosage form that enhancesdrug delivery, whereby augmentation does not refer to the strength ofthe drug in the dosage form), creams (an emulsion, semisolid dosageform, usually containing >20% water and volatiles5 and/or <50%hydrocarbons, waxes, or polyols as the vehicle, whereby this dosage formis generally for external application to the skin or mucous membranes),cream augmented (a cream dosage form that enhances drug delivery,whereby augmentation does not refer to the strength of the drug in thedosage form), emulsion (a dosage form consisting of a two-phase systemcomprised of at least two immiscible liquids, one of which is dispersedas droplets, internal or dispersed phase, within the other liquid,external or continuous phase, generally stabilized with one or moreemulsifying agents, whereby emulsion is used as a dosage form termunless a more specific term is applicable, e.g. cream, lotion,ointment), suspensions (a liquid dosage form that contains solidparticles dispersed in a liquid vehicle), suspension extended release (aliquid preparation consisting of solid particles dispersed throughout aliquid phase in which the particles are not soluble; the suspension hasbeen formulated in a manner to allow at least a reduction in dosingfrequency as compared to that drug presented as a conventional dosageform, e.g., as a solution or a prompt drug-releasing, conventional soliddosage form), pastes (A semisolid dosage form, containing a largeproportion, 20-50%, of solids finely dispersed in a fatty vehicle,whereby this dosage form is generally for external application to theskin or mucous membranes), solutions (a clear, homogeneous liquid1dosage form that contains one or more chemical substances dissolved in asolvent or mixture of mutually miscible solvents), powders, shampoos (alotion dosage form which has a soap or detergent that is usually used toclean the hair and scalp; it is often used as a vehicle for dermatologicagents), shampoo suspensions (a liquid soap or detergent containing oneor more solid, insoluble substances dispersed in a liquid vehicle thatis used to clean the hair and scalp and is often used as a vehicle fordermatologic agents), aerosol foams (i.e., a dosage form containing oneor more active ingredients, surfactants, aqueous or nonaqueous liquids,and the propellants; if the propellant is in the internal discontinuousphase, i.e., of the oil-in-water type, a stable foam is discharged, andif the propellant is in the external continuous phase, i.e., of thewater-in-oil type, a spray or a quick-breaking foam is discharged),sprays (a liquid minutely divided as by a jet of air or steam), meteredspray (a non-pressurized dosage form consisting of valves which allowthe dispensing of a specified quantity of spray upon each activation),suspension spray (a liquid preparation containing solid particlesdispersed in a liquid vehicle and in the form of coarse droplets or asfinely divided solids to be applied locally, most usually to thenasal-pharyngeal tract, or topically to the skin), jellies (a class ofgels, which are semisolid systems that consist of suspensions made up ofeither small inorganic particles or large organic moleculesinterpenetrated by a liquid—in which the structural coherent matrixcontains a high portion of liquid, usually water), films (a thin layeror coating), film extended release (a drug delivery system in the formof a film that releases the drug over an extended period in such a wayas to maintain constant drug levels in the blood or target tissue), filmsoluble (a thin layer or coating which is susceptible to being dissolvedwhen in contact with a liquid), sponges (a porous, interlacing,absorbent material that contains a drug, whereby it is typically usedfor applying or introducing medication, or for cleansing, and whereby asponge usually retains its shape), swabs (a small piece of relativelyflat absorbent material that contains a drug, whereby a swab may also beattached to one end of a small stick, and whereby a swab is typicallyused for applying medication or for cleansing), patches (a drug deliverysystem that often contains an adhesive backing that is usually appliedto an external site on the body, whereby its ingredients eitherpassively diffuse from, or are actively transported from, some portionof the patch, whereby depending upon the patch, the ingredients areeither delivered to the outer surface of the body or into the body, andwhereby a patch is sometimes synonymous with the terms ‘extended releasefilm’ and ‘system’), patch extended release (a drug delivery system inthe form of a patch that releases the drug in such a manner that areduction in dosing frequency compared to that drug presented as aconventional dosage form, e.g., a solution or a prompt drug-releasing,conventional solid dosage form), patch extended release electronicallycontrolled (a drug delivery system in the form of a patch which iscontrolled by an electric current that releases the drug in such amanner that a reduction in dosing frequency compared to that drugpresented as a conventional dosage form, e.g., a solution or a promptdrug-releasing, conventional solid dosage form), and the like. Thevarious topical dosage forms may also be formulated as immediaterelease, controlled release, sustained release, or the like.

The topical dosage form composition contains an active pharmaceuticalingredient and one or more inactive pharmaceutical ingredients such asexcipients, colorants, pigments, additives, fillers, emollients,surfactants (e.g., anionic, cationic, amphoteric and nonionic),penetration enhancers (e.g., alcohols, fatty alcohols, fatty acids,fatty acid esters and polyols), and the like. Various FDA-approvedtopical inactive ingredients are found at the FDA's “The InactiveIngredients Database” that contains inactive ingredients specificallyintended as such by the manufacturer, whereby inactive ingredients canalso be considered active ingredients under certain circumstances,according to the definition of an active ingredient given in 21 CFR210.3(b)(7). Alcohol is a good example of an ingredient that may beconsidered either active or inactive depending on the productformulation.

As used herein, the oral dosage form includes capsules (a solid oraldosage form consisting of a shell and a filling, whereby the shell iscomposed of a single sealed enclosure, or two halves that fit togetherand which are sometimes sealed with a band, and whereby capsule shellsmay be made from gelatin, starch, or cellulose, or other suitablematerials, may be soft or hard, and are filled with solid or liquidingredients that can be poured or squeezed), capsule or coated pellets(solid dosage form in which the drug is enclosed within either a hard orsoft soluble container or “shell” made from a suitable form of gelatin;the drug itself is in the form of granules to which varying amounts ofcoating have been applied), capsule coated extended release (a soliddosage form in which the drug is enclosed within either a hard or softsoluble container or “shell” made from a suitable form of gelatin;additionally, the capsule is covered in a designated coating, and whichreleases a drug or drugs in such a manner to allow at least a reductionin dosing frequency as compared to that drug or drugs presented as aconventional dosage form), capsule delayed release (a solid dosage formin which the drug is enclosed within either a hard or soft solublecontainer made from a suitable form of gelatin, and which releases adrug (or drugs) at a time other than promptly after administration,whereby enteric-coated articles are delayed release dosage forms),capsule delayed release pellets (solid dosage form in which the drug isenclosed within either a hard or soft soluble container or “shell” madefrom a suitable form of gelatin; the drug itself is in the form ofgranules to which enteric coating has been applied, thus delayingrelease of the drug until its passage into the intestines), capsuleextended release (a solid dosage form in which the drug is enclosedwithin either a hard or soft soluble container made from a suitable formof gelatin, and which releases a drug or drugs in such a manner to allowa reduction in dosing frequency as compared to that drug or drugspresented as a conventional dosage form), capsule film-coated extendedrelease (a solid dosage form in which the drug is enclosed within eithera hard or soft soluble container or “shell” made from a suitable form ofgelatin; additionally, the capsule is covered in a designated filmcoating, and which releases a drug or drugs in such a manner to allow atleast a reduction in dosing frequency as compared to that drug or drugspresented as a conventional dosage form), capsule gelatin coated (asolid dosage form in which the drug is enclosed within either a hard orsoft soluble container made from a suitable form of gelatin; through abanding process, the capsule is coated with additional layers of gelatinso as to form a complete seal), capsule liquid filled (a solid dosageform in which the drug is enclosed within a soluble, gelatin shell whichis plasticized by the addition of a polyol, such as sorbitol orglycerin, and is therefore of a somewhat thicker consistency than thatof a hard shell capsule; typically, the active ingredients are dissolvedor suspended in a liquid vehicle), granule (a small particle or grain),pellet (a small sterile solid mass consisting of a highly purified drug,with or without excipients, made by the formation of granules, or bycompression and molding), pellets coated extended release (a soliddosage form in which the drug itself is in the form of granules to whichvarying amounts of coating have been applied, and which releases a drugor drugs in such a manner to allow a reduction in dosing frequency ascompared to that drug or drugs presented as a conventional dosage form),pill (a small, round solid dosage form containing a medicinal agentintended for oral administration), powder (an intimate mixture of dry,finely divided drugs and/or chemicals that may be intended for internalor external use), elixir (a clear, pleasantly flavored, sweetenedhydroalcoholic liquid containing dissolved medicinal agents; it isintended for oral use), chewing gum (a sweetened and flavored insolubleplastic material of various shapes which when chewed, releases a drugsubstance into the oral cavity), syrup (an oral solution containing highconcentrations of sucrose or other sugars; the term has also been usedto include any other liquid dosage form prepared in a sweet and viscidvehicle, including oral suspensions), tablet (a solid dosage formcontaining medicinal substances with or without suitable diluents),tablet chewable (a solid dosage form containing medicinal substanceswith or without suitable diluents that is intended to be chewed,producing a pleasant tasting residue in the oral cavity that is easilyswallowed and does not leave a bitter or unpleasant after-taste), tabletcoated (a solid dosage form that contains medicinal substances with orwithout suitable diluents and is covered with a designated coating),tablet coated particles (a solid dosage form containing a conglomerateof medicinal particles that have each been covered with a coating),tablet delayed release (a solid dosage form which releases a drug ordrugs at a time other than promptly after administration, wherebyenteric-coated articles are delayed release dosage forms), tabletdelayed release particles (a solid dosage form containing a conglomerateof medicinal particles that have been covered with a coating whichreleases a drug or drugs at a time other than promptly afteradministration, whereby enteric-coated articles are delayed releasedosage forms), tablet dispersible (a tablet that, prior toadministration, is intended to be placed in liquid, where its contentswill be distributed evenly throughout that liquid, whereby term ‘tablet,dispersible’ is no longer used for approved drug products, and it hasbeen replaced by the term ‘tablet, for suspension’), tablet effervescent(A solid dosage form containing mixtures of acids, e.g., citric acid,tartaric acid, and sodium bicarbonate, which release carbon dioxide whendissolved in water, whereby it is intended to be dissolved or dispersedin water before administration), tablet extended release (a solid dosageform containing a drug which allows at least a reduction in dosingfrequency as compared to that drug presented in conventional dosageform), tablet film coated (a solid dosage form that contains medicinalsubstances with or without suitable diluents and is coated with a thinlayer of a water-insoluble or water-soluble polymer), tablet film coatedextended release (a solid dosage form that contains medicinal substanceswith or without suitable diluents and is coated with a thin layer of awater-insoluble or water-soluble polymer; the tablet is formulated insuch manner as to make the contained medicament available over anextended period of time following ingestion), tablet for solution (atablet that forms a solution when placed in a liquid), tablet forsuspension (a tablet that forms a suspension when placed in a liquid,which is formerly referred to as a ‘dispersible tablet’), tabletmultilayer (a solid dosage form containing medicinal substances thathave been compressed to form a multiple-layered tablet or atablet-within-a-tablet, the inner tablet being the core and the outerportion being the shell), tablet multilayer extended release (a soliddosage form containing medicinal substances that have been compressed toform a multiple-layered tablet or a tablet-within-a-tablet, the innertablet being the core and the outer portion being the shell, which,additionally, is covered in a designated coating; the tablet isformulated in such manner as to allow at least a reduction in dosingfrequency as compared to that drug presented as a conventional dosageform), tablet orally disintegrating (a solid dosage form containingmedicinal substances which disintegrates rapidly, usually within amatter of seconds, when placed upon the tongue), tablet orallydisintegrating delayed release (a solid dosage form containing medicinalsubstances which disintegrates rapidly, usually within a matter ofseconds, when placed upon the tongue, but which releases a drug or drugsat a time other than promptly after administration), tablet soluble (asolid dosage form that contains medicinal substances with or withoutsuitable diluents and possesses the ability to dissolve in fluids),tablet sugar coated (a solid dosage form that contains medicinalsubstances with or without suitable diluents and is coated with acolored or an uncolored water-soluble sugar), osmotic, and the like.

The oral dosage form composition contains an active pharmaceuticalingredient and one or more inactive pharmaceutical ingredients such asdiluents, solubilizers, alcohols, binders, controlled release polymers,enteric polymers, disintegrants, excipients, colorants, flavorants,sweeteners, antioxidants, preservatives, pigments, additives, fillers,suspension agents, surfactants (e.g., anionic, cationic, amphoteric andnonionic), and the like. Various FDA-approved topical inactiveingredients are found at the FDA's “The Inactive Ingredients Database”that contains inactive ingredients specifically intended as such by themanufacturer, whereby inactive ingredients can also be considered activeingredients under certain circumstances, according to the definition ofan active ingredient given in 21 CFR 210.3(b)(7). Alcohol is a goodexample of an ingredient that may be considered either active orinactive depending on the product formulation.

Treatment regimens may also include numerous dosing regimens. Adescription of acne vulgaris is found in Remingtons p. 1131. For ahuman, various therapeutically effective doses and dosing regimensthereof may be determined from the animal data set forth herein usingknown Allometric Scaling (AS) factors. For example, for a mouse having abody weight of 0.03 kg, the AS factor is around 7 assuming a human bodyweight of 70 kg.

The predictive dosing ranges set forth in Tables 1, 2 and 3 wascalculated assuming that for the high end of the oral dose range, thetop dose given to the Rhino mouse is corrected for the expected lessersensitivity of the human and further increased by 0.5 log dose. The lowdose is 1×10⁶ lower than the high dose. For the high end of the topicaldose, the value was further multiplied by a factor of 20 as humansabsorb only about 5% of the dose compared to 100% by the mouse.

Differences in the animal species sensitivity to various vitamin Danalogs as well as differences in relative absorption of various vitaminD analogs by the skin may also significantly affect the humanefficacious dose compared to that used in the animal studies detailedherein.

EXAMPLES

TABLE 1 COMEDOLYTIC EFFECT OF DAILY TOPICAL APPLICATION OF1,25-DIHYDROXYVITAMIN D3 AND ANALOGS TO THE RHINO MOUSE Comedone AreaCompound* (% Vehicle)** Dose (nmol/kg) N 1,25(OH)₂D₃ 187 ± 30 6.0 6VD-03  90 ± 14 0.62 6 NEL 156 ± 34 7.5 6 NEL 145 ± 24 25 6 Vit-III17-20E 116 ± 15 24 6 (24R)2MD₂ 176 ± 55 2.3 6 2MPregna  63 ± 14 217 62MP  92 ± 20 217 6 2MBisP 97 ± 9 22 6 2MBisP 127 ± 12 69 24 2MBisP 49 ±3 217 36 2MBisP 35 ± 4 694 18 2MBisP 32 ± 7 2187 6 20R-2MBisP 136 ± 17217 12 20R-2MBisP 45 ± 6 694 12 20R-2MBisP 17 ± 3 2187 6 2MTrisP 66 ± 9217 6 FF-44 104 ± 20 69 6 FF-44  47 ± 12 217 12 FF-55 108 ± 35 69 6FF-55 53 ± 8 217 12 HPBS  74 ± 10 217 to 122*** 6 *All compounds wereapplied topically on a daily basis for ca. 3 weeks in vehicle comprisedof 70 vol % ethanol and 30 vol % propylene glycol. **Values are mean ±standard error of the mean ***Dose changed as indicated on day 3 (2animals) or day 10 (4 animals) of the experiment.

TABLE 2 PREDICTIVE HUMAN ORAL DOSING RANGE COMPOUND ORAL DOSING RANGE2MBisP 7.0 mg to 7.0 ng/kg_(BW)/day CAGE-3 700 ng to 0.7 pg/kg_(BW)/day24R-2MD₂ 23 μg to 23 pg/kg_(BW)/day VitIII (17-20E) 230 μg to 230pg/kg_(BW)/day NEL 230 μg to 230 pg/kg_(BW)/day

TABLE 3 PREDICTIVE HUMAN TOPICAL DOSING RANGE COMPOUND TOPICAL DOSINGRANGE 2MBisP 340 mg to 0.34 μg/kg_(BW)/day CAGE-3 14 μg to 14pg/kg_(BW)/day 24R-2MD₂ 450 μg to 0.45 ng/kg_(BW)/day VitIII (17-20E)4.5 mg to 4.5 ng/kg_(BW)/day NEL 4.5 mg to 4.5 ng/kg_(BW)/day VD-03 11μg to 0.11 ng/kg_(BW)/day 2MPregna 340 mg to 0.34 μg/kg_(BW)/day 2MP 340mg to 0.34 μg/kg_(BW)/day 20R-2MBisP 340 mg to 0.34 μg/kg_(BW)/day2MTrisP 34 mg to 34 ng/kg_(BW)/day FF-44 340 mg to 0.34 μg/kg_(BW)/dayFF-55 340 mg to 0.34 μg/kg_(BW)/day HPBS 41 mg to 41 ng/kg_(BW)/day

Rhino mice were used to topically and orally test the compounds andcompositions of the invention. The Rhino mouse is a well-establishedanimal model used to study the comedolytic effects of anti-acne agentsincluding retinoids. (See Boulcier M et al., Experimental Models in SkinPharmacology, 1990, In Pharmacological Reviews 42:127-15). Mirshahpanahand Maibach, 2007, Cutaneous and Ocular Toxicology 26:195-202). TheRhino mouse model was used to study the therapeutic potential of2-Methylene-19-nor-20(S)-1α-hydroxy-bishomopregnacalciferol (2MBisP),19-Nor-26,27-dimethylene-20(S)-2-methylene-1α,25-dihydroxyvitamin D₃(CAGE-3), NEL, 24R-2MD₂, Vit-III (17-20E), 2MPregna, 2MP, 20R-2MbisP,2MTrisP, FF-44, FF-55, HPBS, VD-03 and atRA. The data herein establishesthat some, but not all, vitamin D analogs produce a substantialreduction in comedone size at the dose(s) tested.

Further, there is a synergistic effect by administering a combination of2MBisP and atRA. The synergistic effect is evidenced by a substantialreduction in comedone size as compared to vehicle alone, 2MBisP alone oratRA alone. The synergistic effect is further evidenced by a substantialreduction in comedone size upon administering atRA at a low andpreviously-ineffective dose. By rendering such a low andpreviously-ineffective atRA dose now effective, potential side effectscaused by administration of atRA can be minimized or avoided.

Animals and dose administration. Rhino mice 6-10 weeks old were dosedvia the oral and/or topical route. In the majority of studies, the micewere dosed daily. In one topical study, the efficacy of daily versusintermittent (Monday/Wednesday/Friday) dosing was compared. The micewere weighed three times per week and doses were adjusted weekly basedon body weight. The topical formulations were applied to the back of theanimal in a maximum volume of 110 μL. The topical formulations were madeby mixing the APIs with a topical carrier comprising 70 vol % propyleneglycol and 30 vol % ethanol or 30 vol % propylene glycol and 70 vol %ethanol, as indicated. The topical vehicle control was the vehiclecarrier solution matched to the formulation containing API and vehiclecarrier.

The oral formulation was made by mixing the APIs with Wesson® soybeanoil or NeoBee® oil. The oral dose was delivered to the back of the mouthof each mouse. Mice were sacrificed 4 hours after the final oral doseand 72 hours after the final topical dose. At sacrifice, the dorsal skinwas collected for histological studies.

Comedolytic effect. The extent of the comedolytic effect (i.e.,efficacy) was assessed by measuring the average area of the comedones,whereby the smaller the area, the larger the effect. The comedone areawas determined by histological analysis of tissue sections based on amethod developed in our lab (see FIG. 2). Skin was fixed overnight in 4%paraformaldehyde at 4 deg. C. with gentle agitation and dehydrated thenext day into 100% methanol. Samples were embedded in paraffin and atotal of nine 10 micron sections 150 microns apart were prepared fromeach Rhino mouse. Five of the nine sections were digitally imaged (6×magnification) for comedone analysis using Metamorph Imaging Software(trace function). The perimeter of each comedone on the images takenfrom the 5 sections was then traced using a Wacom Intuos 3 GraphicsTablet interfaced with the software. The number of pixels comprising thearea of each individual comedone was obtained and transferred to anExcel spreadsheet, and the mean number of pixels per comedone wasobtained for each Rhino mouse. For comedones that were completely healed(area=0) a pixel value approaching 0 (<10) was entered into thespreadsheet. The individual comedone area average for each mouse wasthen used to calculate the treatment group mean. Results in the figuresare expressed in terms of mean±standard error of the mean.

Preparation of oral dosing solutions containing 2MBisP, CAGE-3,24R-2MD₂, VitIII (17-20E) and NEL. Separate concentrated stocks of2MBisP, CAGE-3, 24R-2MD₂, VitIII (17-20E) and NEL were obtained inethanol. The concentration was determined spectrophotometrically using amolar extinction coefficient=42,000 and a λ_(max)=252.7. Oral dosingsolutions were prepared by adding the appropriate volume of theethanolic solution to oil (NeoBee® or Wesson®) whereby the finalconcentration of ethanol does not exceed 5 vol %. The final dose wasdelivered in ≦50 μL of oil.

Preparation of topical formulations containing 2MBisP, CAGE-3, 24R-2MD₂,VitIII (17-20E), NEL, VD-03, 2MPregna, 2MP, 20R-2MBisP, 2MTrisP, FF-44,FF-55, and HPBS. Separate concentrated ethanolic stocks of 2MBisP,CAGE-3, 24R-2MD₂, VitIII (17-20E) and NEL were diluted to a finalconcentration containing 70 vol % propylene glycol and 30 vol % ethanolor 30 vol % propylene glycol and 70 vol % ethanol as the excipientcarrier system. The mixture was thoroughly mixed. The topical dosingformulation delivered the desired dosing amount of drug on a perkilogram body weight basis. A dose ranging from 100-110 μL in volume wasadministered to the back of the mouse. An average weight of 24 or 30g/mouse was assumed in dose volume calculations. Dosing volumes wereadjusted weekly to deliver the desired dosing amount of API based on thebody weight of each individual animal.

Preparation of oral atRA dosing formulation. A concentrated stocksolution containing atRA was prepared in dichloromethane. The atRAconcentrated stock solution was diluted into ethanol. The concentrationof atRA in that diluted stock solution was determinedspectrophotometrically, whereby the molar extinction coefficient=45,200and λ_(max)=350. The purity of atRA was determined to be >99% by HPLC.The appropriate volume of atRA was added to Wesson® oil, the sample wasmixed, and the residual dichloromethane was removed by flushing the oilwith argon for 3 hours under a vapor hood. The final dose was deliveredorally using ≦50 μL of oil.

Methods. Animals and dose administration. Rhino mice 6-10 weeks old weredosed via the oral route. The mice were dosed daily. The mice wereweighed three times per week and doses were adjusted weekly based onbody weight. The oral formulation was made by mixing the APIs withWesson® soybean oil. The oral dose was delivered to the back of themouth of each mouse. Mice were sacrificed 4 hours after the final oraldose. At sacrifice, the dorsal skin was collected for histologicalstudies.

We claim:
 1. A composition for use in treating acne, the compositioncomprising a therapeutically effective dose of a 19-nor-containingvitamin D compound, a stereoisomer thereof, a salt thereof or a solutethereof, wherein the 19-nor-containing vitamin D compound has thestructure:

wherein R₁ is selected from the group consisting of

wherein R₂ is selected from the group consisting of ═CH₂ and


2. The composition of claim 1, wherein the compound is

(2MbisP), a stereoisomer thereof, a salt thereof, and a solute thereof.3. The composition of claim 1, wherein the compound is

(2MPregna), a stereoisomer thereof, a salt thereof, and a solutethereof.
 4. The composition of claim 1, wherein the compound is

(2MP), a stereoisomer thereof, a salt thereof, and a solute thereof. 5.The composition of claim 1, wherein the compound is

(20R-2MbisP), a stereoisomer thereof, a salt thereof, and a solutethereof.
 6. The composition of claim 1, wherein the compound is

(2MTrisP), a stereoisomer thereof, a salt thereof, and a solute thereof.7. The composition of claim 1, wherein the compound is

(FF-44), a stereoisomer thereof, a salt thereof, and a solute thereof.8. The composition of claim 1, wherein the compound is

(FF-55), a stereoisomer thereof, a salt thereof, and a solute thereof.9. The composition of claim 1, wherein the compound is:

(HPBS), a stereoisomer thereof, a salt thereof, and a solute thereof.10. The composition of claim 1 further comprising a therapeuticallyeffective dose of a retinoid compound.
 11. The composition of claim 10,wherein the retinoid compound is selected from the group consisting of13-cis-retinoic acid, all-trans-retinoic, 9-cis-retinoic acid,acitretin, adapalene, bexarotene, tamibarotene, tazarotene, retinoylt-butyrate, retinoyl pinacol and retinoyl cholesterol, an isomerthereof, an ester thereof, a salt thereof, and a solute thereof.
 12. Thecomposition of claim 11, wherein the retinoid compound is13-cis-retinoic acid.
 13. The composition of claim 10, wherein thecomposition comprises (1) a therapeutically effective dose of 2MbisP, astereoisomer thereof, a salt thereof, and a solute thereof, and (2) atherapeutically effective dose of 13-cis-retinoic acid, an isomerthereof, an ester thereof, a salt thereof, and a solute thereof.
 14. Thecomposition of claim 13, wherein the 2MbisP, the stereoisomer thereof,the salt thereof, and the solute thereof is administered topically, andthe 13-cis-retinoic acid, the isomer thereof, the ester thereof, thesalt thereof, and the solute thereof is administered orally.
 15. Thecomposition of claim 1, wherein the compound is administered topically.16. The composition of claim 1, wherein the compound is administeredorally.
 17. The composition of claim 1, wherein the compound furthercomprises a pharmaceutically acceptable carrier system, the carriersystem comprising 30% to 70% ethanol and 70% to 30% propylene glycol.18. A method of treating a skin disorder, comprising administering aneffective amount of a composition comprising a therapeutically effectivedose of a 19-nor-containing vitamin D compound, a stereoisomer thereof,a salt thereof or a solute thereof, wherein the 19-nor-containingvitamin D compound has the structure:

wherein R₁ is selected from the group consisting of

wherein R₂ is selected from the group consisting of ═CH₂ and

and wherein the composition is administrable daily or intermittently andwherein the symptoms of the skin disorder are treated.
 19. The method ofclaim 18, wherein the compound is

(2MbisP), a stereoisomer thereof, a salt thereof, and a solute thereof.20. The method of claim 18, wherein the compound is

(2MPregna), a stereoisomer thereof, a salt thereof, and a solutethereof.
 21. The method of claim 18, wherein the compound is

(2MP), a stereoisomer thereof, a salt thereof, and a solute thereof. 22.The method of claim 18, wherein the compound is

(20R-2MbisP), a stereoisomer thereof, a salt thereof, and a solutethereof.
 23. The method of claim 18, wherein the compound is

(2MTrisP), a stereoisomer thereof, a salt thereof, and a solute thereof.24. The method of claim 18, wherein the compound is

(FF-44), a stereoisomer thereof, a salt thereof, and a solute thereof.25. The method of claim 18, wherein the compound is

(FF-55), a stereoisomer thereof, a salt thereof, and a solute thereof.26. The method of claim 18, wherein the compound is:

(HPBS), a stereoisomer thereof, a salt thereof, and a solute thereof.27. The method of claim 18 further comprising administering atherapeutically effective dose of a retinoid compound.
 28. The method ofclaim 27, wherein the retinoid compound is selected from the groupconsisting of 13-cis-retinoic acid, all-trans-retinoic, 9-cis-retinoicacid, acitretin, adapalene, bexarotene, tamibarotene, tazarotene,retinoyl t-butyrate, retinoyl pinacol and retinoyl cholesterol, anisomer thereof, an ester thereof, a salt thereof, and a solute thereof.29. The method of claim 28, wherein the retinoid compound is13-cis-retinoic acid.
 30. The method of claim 27, wherein thecomposition comprises (1) a therapeutically effective dose of 2MbisP, astereoisomer thereof, a salt thereof, and a solute thereof, and (2) atherapeutically effective dose of 13-cis-retinoic acid, an isomerthereof, an ester thereof, a salt thereof, and a solute thereof.
 31. Themethod of claim 30, wherein the 2MbisP, the stereoisomer thereof, thesalt thereof, and the solute thereof is administered topically, and the13-cis-retinoic acid, the isomer thereof, the ester thereof, the saltthereof, and the solute thereof is administered orally.
 32. The methodof claim 14, wherein the compound is administered topically or orally.